Mental Health Service Use in Depressed Military Personnel: A Systematic Review

Abstract

Introduction Major depression is a leading cause of morbidity in military personnel and an important impediment to operational readiness in military organizations. Although treatment options are available, a large proportion of individuals with depression do not access mental health services. Quantifying and closing this treatment gap is a public health priority. However, the scientific literature on the major depression treatment gap in military organizations has never been systematically reviewed. Methods We systematically searched the EMBASE, MEDLINE, and PsychINFO databases for studies measuring recent mental health service use in personnel serving in the armed forces of a Five-Eye country (Australia, Canada, New Zealand, the United Kingdom, or the United States). We excluded studies conducted with retired veterans. Because of the substantial heterogeneity in included studies, we did not pool their results. Instead, we computed median period prevalence of mental health service use. Results Twenty-eight studies were included in the systematic review; 12 had estimated mental health service use in personnel with depression, and another 16 had estimated mental health service use in personnel with depression or another mental health disorder. The period prevalence of mental health service use in depressed military personnel ranged from 20 to 75% in 12 included studies, with a median of 48%, over 2–12 months. The other 16 studies yielded similar conclusions; they reported period prevalence of mental health service use in personnel with any mental health disorder ranging from 14 to 75%, with a median of 36%, over 1–12 months. The median was higher in studies relying on diagnostic interviews to identify depressed personnel, compared to studies relying on screening tools (60% vs. 44%). Conclusions There is a large treatment gap for major depression in particular, and for mental health disorders in general, among military personnel. However, our results highlight the association between the use of measurement tools and treatment gaps: estimated treatment gaps were larger when depressed patients were identified by screening tools instead of diagnostic interviews. Researchers should be wary of overestimating the mental health treatment gap when using screening tools in future studies.

The global prevalence of depression, suicide ideation, and attempts in the military forces: a systematic review and Meta-analysis of cross sectional studies

“…Military personnel often suffer from disorders in sleep, nutrition, physical exertion, concentration, as well as anorexia, and weight changes due primarily to job sensitivity and confidential activities. The presence of these behaviors and emotions over time and their stability for a long time have a negative effect on the mood of these people and can expose a military person to depression [ 24 , 45 ]. In the present meta-analysis, the pooled prevalence of depression after combining studies in which the available sampling method had been used, was equal to 21% and after combining studies that had used random sampling method to collect their samples, the pooled prevalence of depression was equal to 26%.…”

“…So far, various descriptive and analytical studies have been conducted in the world with the aim of determining the prevalence of mental disorders, especially depression and suicide in servicemen in various fields such as naval, land and air forces, but the results of these studies were very contradictory. So far, various studies with different sample sizes in the world have been conducted to determine the prevalence of depression and suicide (thoughts or attempted) in the military, but the results of these studies showed the wide prevalence of these consequences in the military and so far, the exact prevalence of them in these communities has not been determined [ 7 , 22 – 24 ]. The unavailability of the exact prevalence of depression and suicide in the military prevents the development of appropriate mental health programs and interventions for the military.…”

The Global Prevalence of Depression, Suicide Ideation, and Attempts in the Military Forces: A Systematic Review and Meta-Analysis of Cross Sectional Studies

“…Military personnel often suffer from disorders in sleep, nutrition, physical exertion, concentration, as well as anorexia, and weight changes due primarily to job sensitivity and con dential activities. The presence of these behaviors and emotions over time and their stability for a long time have a negative effect on the mood of these people and can expose a military person to depression (39,40). In the present meta-analysis, the pooled prevalence of depression after combining studies in which the available sampling method had been used, was equal to 21% and after combining studies that had used random sampling method to collect their samples, the pooled prevalence of depression was equal to 26%.…”

<p>Machine Learning Methods to Evaluate the Depression Status of Chinese Recruits: A Diagnostic Study</p>

“…In Canada, screening mostly relies on interviews, while in the United States, screening tools are used. 14,15 Nevertheless, self-reported data on the psychological dimension improve model performance. A machine-learning technique was applied in Britain in a study of 13,690 current or former servicemen and found out that self-report could effectively distinguish those with PTSD.…”

“…12,13 The depressive status of military personnel is unique because of the violent training in the military, while they do not have to bear or witness violence in the real world. 14,15 Recruits can be apprehensive toward this violence and resentful at mandatory military service. 16,17 According to a research on the prevalence of depression and associated factors among military personnel, having siblings, military work type, smoking, a sick person at home, and problematic relations with fathers, co-workers, supervisors, subordinates, and relatives are the main factors associated with an increased likelihood of depression.…”